The Gordon R. Irlam Charitable Foundation
23 Coronado Ave
Los Altos, CA 94022

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2020-09-28
Purpose: Quarterly expense report
Reference: 2020-GRICF-03

Date Category* Description Amount
2020-07-05    Health    Insurance   $721.00
2020-08-05    Health    Insurance   $721.00
2020-08-22    Health    Prescription   $40.00
2020-09-05    Health    Insurance   $721.00
Total expenses   $2203.00
Less advances   $0.00
Reinbursement due   $2203.00

* - Valid categories: Grants, Travel, Pubs, Office, Health, Programs, Other
Travel includes conf./meetings, transport, car-$0.575/mile, lodging, M&IE

Signature:

Approved by: Manjula Jonnalagadda

Signature:

Date: